Although CBD is thought to have minimal side effects, there are some things you need to know before you opt to try it for yourself. Cannabidiol is often used for easing the symptoms of chronic pain, anxiety, and sleep problems, as well as a variety of conditions. However, CBD does come with one caveat that you cannot ignore if you are taking specific medications: it can change how you metabolize certain substances.
This article covers exactly what you need to know about CBD and medications, so you can have an informed conversation with a medical professional.
How Can CBD Affect Medications?
There are presently 562 known drug interactions between CBD and specific medications [1]. 13 medications will have a significant interaction, while 499 cause moderate interactions. These interactions can occur in a couple of ways:
- Interfering with the liver and CYP450 enzymes. Similar to grapefruit, CBD changes how the liver metabolizes certain drugs. This can occur through hepatic impairment when CBD is taken with certain drugs, or the liver enzyme cytochrome P450 becoming desensitized [2]. According to research, CYP450 is an essential group of enzymes that metabolizes cannabinoids [3]. Within the cytochrome P450 group, there is one enzyme, CYP3A4, that is tasked with removing about 60 percent of medications. Should CBD interfere with this enzyme, it will lead to medications remaining in your system. Should the liver be unable to fully metabolize a drug, it could lead to more of the drug remaining in the body, causing negative side effects.
- The anti-inflammatory and immunomodulatory abilities of CBD can interfere with drugs that have the same effects.
- Higher doses of CBD may enhance the sedative effects of certain drugs for dopamine or serotonin receptors, as well as the central nervous system. This includes alcohol, antidepressants, opioids, benzodiazepines, and barbiturates.
Look For The Grapefruit Warning
If you want to know whether you should be taking CBD alongside your medication, it is best to read the labels on your prescriptions. Generally, you should not use CBD if you are on any medication that comes with a grapefruit warning.
Why is grapefruit to be avoided? Because grapefruit and similar fruits, including pomelos and tangelos, contain something called furanocoumarins. The chemicals inhibit CYP450, slowing medication metabolism. CBD does the same thing.
Therefore, if you know that you have to avoid grapefruit, consider staying away from CBD as well.
Types of Medications With a Grapefruit Warning
- Antimicrobials and antibiotics
- Antihistamines
- Anticancer medications
- Antiepileptic drugs
- Cholesterol medications
- Blood pressure medications
- Corticosteroids
- Gastrointestinal medications
- Erectile dysfunction drugs
- Immunosuppressants
- Heart rhythm medications
- Analgesics, including NSAIDs
- Prostate medications
- Antidepressants
- Anti-anxiety medication
- Thyroid medication
Current Research on Interactions Between Medications and CBD
As CBD becomes more prolific, it has become increasingly important to figure out how CBD interacts with medications. Researchers have been hard at work to see how cannabidiol and various medications impact one another. However, many of these studies have been done on animal subjects, and it is difficult to say how certain interactions translate to people.
In one study, 25 children with epilepsy were given CBD and clobazam [4]. In the 13 children given both, researchers found that the levels of clobazam were elevated, as predicted. While there were no severe interactions, researchers caution that the amount of clobazam is monitored during treatment.
In a similar study, 42 children and 39 adults taking antiepileptic medication (AEDs) were also given Epidiolex alongside their AEDs [5]. The dosage of CBD was increased after 2 weeks. During this time, the researchers looked at the serum levels of the antiepileptic drugs and found that desmethylclobazam and clobazam had gone beyond the therapeutic range.
In 2017, a study looking at the use of CBD alongside Levothyroxine, a thyroid medication, found that the medication had not been properly metabolized [6]. This could lead to a potentially dangerous buildup of thyroxine, causing a patient to go into hyperthyroidism.
A review from 2021 compiled all known drug-drug interactions concerning CBD and also found that CBD inhibits the enzyme CYP2D6, which may impact serotonin reuptake inhibitors (SSRIs), antipsychotics, beta-blockers, tricyclic antidepressants, and opioids [7]. Furthermore, CBD interacts with monoamine oxidase inhibitors (MAOIs), resulting in the substances remaining in the body for longer periods of time, leading to unpleasant side effects. The review went on to say that, while not all drug-drug interactions cause adverse effects, the increase in risk should not be underestimated.
Does The Kind of CBD and Dose Matter When Taking Medication?
Yes, it does matter. There are a couple types of CBD, such as broad-spectrum, full-spectrum, and isolate. Broad and full spectrum formulas contain a variety of cannabinoids and terpenes that can interact with medications. Since the effects of these chemicals has yet to be fully researched, there is no telling what those reactions may be. CBD isolate, on the other hand, contains only CBD and non-cannabis ingredients, such as flavorings or oils.
If you are looking to limit potential side effects or interactions from CBD, an isolate may be the best choice.
Furthermore, CBD is biphasic, meaning that the effects differ depending on the dosages [8]. A low dose of CBD may stimulate you, while a higher dose could act as a sedative.
You must also consider whether you are ingesting your CBD as an edible, taking it sublingually, or using it on your skin. Depending on how you take CBD, how soon you feel the effects and how long they last is different. A topical cream will only penetrate the skin but not the bloodstream. Meanwhile, edibles last much longer than a tincture under the tongue.
All that said, any time you wish to add CBD as a complement to your medication, it is best to speak with your doctor first. Never try CBD without consulting with a medical professional first, as they can help you weigh the risks and benefits.
Looking For High-Quality CBD?
Cannabidiol may be well tolerated by most people and cause minimal side effects, but that does not mean it is for everyone. Complications may arise when someone taking medications attempts to use CBD at the same time. As such, if you are currently looking to add CBD to your daily regimen but are on certain medications, such as those with a grapefruit warning, it is best to avoid CBD or speak with your doctor first.
All clear to give CBD a try? Check out the products from Sugar Bottom Hemp. Our store is packed with top-quality CBD isolate extracted from organically grown hemp. Each product is tested in a third-party lab, as well. Check out our full lineup today. Have questions? Send us a message!
Resources
- Cannabidiol Drug Interactions. Drugs.com. (n.d.). Retrieved January 30, 2023, from https://www.drugs.com/drug-interactions/cannabidiol-index.html
- McDonnell, PharmD, BCOP, A. M., & Dang, PharmD, BCPS, C. H. (2013). Basic Review of the Cytochrome P450 System. Journal of the Advanced Practitioner in Oncology, 4(4). https://doi.org/10.6004/jadpro.2013.4.4.7
- Alsherbiny, M., & Li, C. (2018). Medicinal Cannabis—Potential Drug Interactions. Medicines, 6(1), 3. https://doi.org/10.3390/medicines6010003
- Geffrey, A. L., Pollack, S. F., Bruno, P. L., & Thiele, E. A. (2015). Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia, 56(8), 1246–1251. https://doi.org/10.1111/epi.13060
- Gaston, T. E., Bebin, E. M., Cutter, G. R., Liu, Y., & Szaflarski, J. P. (2017). Interactions between cannabidiol and commonly used antiepileptic drugs. Epilepsia, 58(9), 1586–1592. https://doi.org/10.1111/epi.13852
- Julia, N. (2022, January 22). CBD and levothyroxine: What happens when you mix them together? CFAH. Retrieved January 30, 2023, from https://cfah.org/cbd-and-levothyroxine/
- Balachandran, P., Elsohly, M., & Hill, K. P. (2021). Cannabidiol Interactions with Medications, Illicit Substances, and Alcohol: a Comprehensive Review. Journal of General Internal Medicine, 36(7), 2074–2084. https://doi.org/10.1007/s11606-020-06504-8
- Rey, A. A., Purrio, M., Viveros, M. P., & Lutz, B. (2012). Biphasic Effects of Cannabinoids in Anxiety Responses: CB1 and GABAB Receptors in the Balance of GABAergic and Glutamatergic Neurotransmission. Neuropsychopharmacology, 37(12), 2624–2634. https://doi.org/10.1038/npp.2012.123
